Neurosciences Length of Stay Project

Neurosciences Length of Stay Project

Helen Tassell and Steven Wood, Prince of Wales Hospital, South Eastern Sydney Local Health District

Summary

The Prince of Wales Hospital (POWH) is a tertiary hospital and a Neurosciences hub, providing specialist Neurology and Neurosurgery services. It was identified that length of stay (LoS) for neurosciences patients at the POWH was above the state benchmark. A multidisciplinary project was undertaken to explore opportunities to optimise the patient journey and improve access to services and reduce LoS.

Evaluation reveals impressive results with improved access to beds due to patient flow, enhanced coordination of care more than 20% reduction in length of stay for this patient group, saving 8.4 acute beds.

Post Acute Discharge Planning

Availability of community resources and equipment particularly those appropriate for neurosciences casemix.

Acute Care Plan Coordination

Multiple teams involved in patient care may impact ownership of the patient and discharge decisions

Defined management plan for patients

Clarity of medical and allied health goals

Frequency and timeliness of family conferences

Effectiveness and timeliness of discharge planning

Clarity of Estimated Date of Discharge (EDD) and destination in discharge planning meetings

<20% of patients were set an EDD in discharge planning meeting

Patients reviewed over 48 hours after admission to Parkes 8 by some allied health disciplines

Medical Governance

Medical decision making at the junior level impacted timeliness of discharge planning

Feasibility of definitive Consultant ward rounds

Solutions

Improve Communication

Notification of Complex Care Patient (NoCCuP) ToolTool to notify staff that patient is at high risk of long length of stay compared to their admitted diagnosis-related group. This will cover early referrals to relevant parties, follow-up and patient flow and checklists for early discharge planning and improved patient flow.

Discharge planning meetings

Medical Intern Education

Patient expected LoS Guidelines

Rehabilitation guidelines

Improve discharge planning

Family ConferenceImprove family conference process by having a documented invitation for the family / patient, goals and planning sheet and formal documentation of meeting outcomes including plans, follow-up and major decisions made for in Patients medical files. Introduction of a "Family Conference" sticker for in patient's progress notes to highlight when family conference has occurred.

Discharge checklists

Setting EDD

Leadership and accountability

Complex Care PathwayThe pathway will build understanding of factors that keep patients in hospital longer than their acute illness and the impact positive impacts on patient care provided a coordinated approach is taken. It will cover early referrals highlighted by the NoCCuP tool, family conference documentation, discharge goals and planning, and checklists for early discharge planning and improved patient flow.

Complex Care Coordinator

Key Worker

Results

Achievement for year to date May 2013 in comparison to 2011/12:

Decreased LoS in Neurology by 23%, equating to 1,796 bed days saved or 4.9 beds at 100% occupancy

Decreased LoS in Neurosurgery by 22%, equating to 1,285 bed days saved or 3.5 beds at 100% occupancy

Figure: Comparison of POWH Neurology (NR) and Neurosurgery (NSx) average LoS and number of acute episodes

more efficient multidisciplinary approach, including understanding of LoS targets and benchmarks

timely establishment of estimated date of discharge

increased family participation in discharge planning processes, such as family conferences

Current strategies in development to further facilitate increased coordination of the patient journey:

Recruitment of complex care coordinator

Development of a complex care pathway

Development of the NoCCuP tool

Conclusion

A multidisciplinary approach has been shown to have a positive impact on improving the patient journey, including decreasing LoS; increasing patient and family participation; and improving staff morale. Working parties will continue to develop and implement evidence based solutions to further enhance coordination of patient care.